Lecture 26 Management of Type 2 Diabetes Part 2 Flashcards

1
Q

Name a DPPIV Inhibitor

A

Gliptins
• Sitagliptin
• Saxagliptin
• Vidaglip

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2
Q

What is the function of Gliptins

A

are DPP-4(enzyme) inhibitors that delay the breakdown of incretins and thereby increase active incretin levels

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3
Q

What are the advantages of Gliptins

A
  • Usually well tolerated
  • Can be used as 2nd or 3rd line agent
  • Can be used in renal impairment
  • No risk of hypoglycaemia
  • Weight neutral
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4
Q

What are the disadvantages of Gliptins

A
  • Trial data shows relatively small effects on glycemic control
  • CI in pregnancy and breastfeeding.
  • Possible increased risk of pancreatitis and pancreatic cancer
  • SE:nausea
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5
Q

What are GLP-1 analogues

A

• Increase release of incretins

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6
Q

What are the advantages of GLP-1 analogues

A
  • Weight loss
  • No risk of hypoglycaemia
  • 3rd line agent
  • Can be used with basal insulin
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7
Q

What are the disadvantages of GLP-1 analogues

A
  • Injection
  • Very expensive
  • Possible increased risk of pancreatitis and pancreatic cancer
  • CI in pregnancy and breastfeeding.
  • SE:Nausea, vomiting
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8
Q

Whats the mechanism of SGLT2 inhibitors

A
  • Increases excretion of glucose

* Reduces the amount of glucose reabsorbed by kidney in proximal tube

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9
Q

What are the effects of Gliflozins

A
  • Leads to increased urinary glucose excretion
  • Glycosuria
  • Lowers HbA1C
  • Gets ride of water/osmotic diuresis
  • Postural hypotension
  • Dehydration
  • Get rid of calories/waste glucose
  • Lose weight with same intake
  • Get rid of sodium/less reuptake
  • Lowers systolic blood pressure
  • Greater risk of urogenital pressure
  • Cystitis and Candidiasis
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10
Q

Advantages of SGLT2 inhibitors

A
  • Weight loss
  • No risk of hypoglycaemia
  • Good effects on glycemic control
  • May have beneficial effect on cardiovascular morbidity & mortality
  • 2nd or 3rd line agent
  • Can add to insulin regimens in T2DM
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11
Q

Disadvantages of SGLT2 inhibitors

A
  • Expensive
  • SE:UTI, fungal infections, osmotic symptoms
  • Risk of digital amputation
  • Risk of DKA
  • CI in pregnancy and breastfeeding.
  • Cannot use in renal impairment
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